A Mobile Health Monitoring Application for

Obesity Management and Control Using the

Internet-of-Things

1Mohamed Alloghani, 1Abir Jaafar Hussain, 1Dhiya Al-Jumeily, 1Paul Fergus, 1Omar Abuelma'atti, 2Hani Hamdan 1Applied Computing Research Group

Department of Computer Science

Liverpool John Moores University

Liverpool, Merseyside, UK

2Department Signal & Statistics

CentraleSupélec

Plateau de Moulon

France

{M.AlLawghani@2014.ljmu.ac.uk; A.Hussain, D.Aljumeily, P.Fergus, O.E.Abuelmaatti}@ljmu.ac.uk,

Hani.Hamdan@centralesupelec.fr

Abstract— Obesity is one of the most serious and dangerous

nutritional diseases around the world. Usually, people develop patterns

of unhealthy eating that lead to increased body weight and

accumulation of fat in the body. This mass happens due to an

imbalance between the energy intake from food and energy consumed

in the body. One of the primary treatments for this serious health risk

include diets, physical activity, weight-loss training and adoption of

health programs that promote healthy eating. As such, reliable

mechanism to prevent and control the obesity levels is vital. It led many

experts and researchers who are interested in the health sector to

explore more solutions that help to combat the obesity phenomenon.

This paper presents a mobile health application intended to increase

the awareness levels of parents and children about the obesity risks and

help them to sustain balanced and healthy eating lifestyle. The

proposed mobile application is an educational tool for the evaluation

of interventions to prevent obesity risk levels. The application is based

on the Internet-of-Things approach, which allows tracking food

intake, remote capturing and constant monitoring of children data

with interactive feedback displayed on the mobile application.

Keywords— Internet of Things, eHealth, mHealth, Geolocation,

Internet

I. INTRODUCTION

The prevalence of obesity among children, youth and adults have

become a serious problem worldwide. According to [1], the prevalence

of obesity among middle-aged adults 40.2% and older adults aged 60

and above 37% that was significantly higher than adults aged 20-39

(32.3%). A recent study [2] showed that adults in UK spend on average

more than five hours a day sedentary. Another study [3] indicated that

in England, the age group of 13-15 years old of boys who spent the

lowest sedentary time compared to Scotland and Northern Ireland. The

study [3] also reported that obesity and overweight rates increased by a

2-3% in France, Australia, Switzerland and Mexico but have been stable

in Canada, Italy, England, United States, Spain and Korea. On the other

hand, the Gulf Countries witnessed a freighting rise in the obesity rates

particularly Qatar and Kuwait, which recorded the highest female

obesity rates worldwide [5]. According to a recent study [6], [7] showed

that more than 60% of the UAE locals are obese and this figure is

expected to rise. The data trend is not slowing down and the number of

obese adults and children continued to increase dramatically. Authors

in [4] suggested methods to prevent obesity such as frequent health

checkups, prevention of lifestyle diseases and adoption of changes in

consumption and eating patterns. In UAE, the child obesity reached

alarming proportion levels where more than 40% of children are either

overweight or obese [8]. In most cases, the lack of parental attention and

not spending enough time can lead children to suffer some health issues

and behavioral problems. Such behavioral changes will negatively

motivate them to consume meals, including high calorie foods, unhealthy

food like chocolate, chips, pizza and burger away from home. This makes

it very difficult for parents to control their children's food choices and

time of meals. The parents should practice their role and promote healthy

lifestyle behaviors among their children. The parental involvement can

help to prevent and mitigate the obesity levels of children by providing

the required guidance and food orientation to children to foster healthy

lifestyle and become aware of nutritional facts of each meal before their

undertake [9]. In recent years, many eHealth and mHealth solutions

presented and successfully implemented taking the advantages of recent

computing technologies and mobile powerful advancements. Such

solutions offer many level of services to users and huge intensity of

interaction including the data exchange, information retrieval and user's

feedback details [10]. Improving the healthcare outcomes require the

adoption of a suitable solution that will facilitates enhancements of

medical care outcomes [11]. The Internet of Things (IoT) can provide a

useful tool to achieve this need. The IoT is a newly developed approach

that is core objective to achieve and facilitate the communications

between smart objects such as devices, sensors, vehicles, applications and

enable these objects to collect and exchange data [12]. Nowadays, the

mobile devices are equipped with advanced sensors and features such as

the Bluetooth technology, GPS, NFC, Wi-Fi, voice recognition that make

mobile device a prospective tool [13].

This paper presents a mobile health monitoring application to help

prevention of obesity levels in children and encourage them to become

well educated about healthy nutritional practices. The paper is organized

as follows Section II presents a brief review of related work. Section III

provides a summary for the architecture of the proposed solution using

the IoT concept. Section IV outlines the technologies used in the proposed

mobile App. Section V details the evaluation and analysis of the system.

Section VI describes the conclusion and future work.

II. RELATED WORK

Many studies demonstrated that mobile applications could offer

interesting useful solutions to promote healthier lifestyle. Some works

reported in [14] and [15] indicated that most of these proposed

applications designed to a targeted group of people such as adults and

elderly. The work in [16] presented a mobile health architecture

intended to prevent the obesity in children through a set of mHealth

applications. Another example of mobile monitoring application

designed to prevent the obesity of adult patients is myPace [17] that is

a management system for behavior change of complete patients' weight

loss deployed on smartphone devices. According to [18], [19] some

interesting collaborative games for obesity prevention and control were

developed for adults and youth. The majority of the existing research

development of mobile applications for the prevention of obesity have

focused on adults, adolescents and elderly. Very few studies focused on

children' obesity prevention using the latest advancement of mobility

and ubiquity capabilities. On the other hand, several Apps are available

on different mobile platforms to download for fitness, diabetes, obesity

and health control [20]. However, most of these mobile Apps

considered as stand-alone applications, which are not adequate to

prevent obesity of children, as they need to receive a proper orientation

and guidance from their parents or adults who may support them to

maintain a healthy lifestyle. There is currently a lack of rigorous

research and assessment to determine the best practices for feasible

healthcare solutions. Most of the published literature focused on

prevention of chronic diseases using health apps. To some extent, it's

not clear how these mobile Apps can be successful at facilitating the

prevention of children obesity and health behavior change [20]. In the

U.S., around 90% of healthcare service providers have deployed mobile

devices that engage with patients [21]. Authors in [22] present an

android application designed for elderly caregivers. This App takes into

account the feature of SMS to send messages to an elders' device

without any intervention, locate his place through GPS location, and

send these details to a caregiver to provide required medication where

required.

In this paper, a novel implementation is proposed for the use of

mobile App for children, parents and healthcare professionals. The

children will only be able to use this App with the permission of their

parents. The children who are above the age of 13 can use this App. The

system utilizes the social media services including the Facebook and

Instagram that requires kids’ age to be 13 years and older to sign up

with these services. Aside from this, the mobile App complies with the

Children Online Privacy Protection Act (COPPA) [34]. On the other

hand, the App utilizes the features of the newly emerged concept of IoT

for data capturing and information retrieval of foodstuff items. A

fitness-tracking device fitted with 3D motion sensor is used for tracking

children steps, distances travelled and burned calories. The quick

response code (QR-Code) is used to decode the nutrimental information

of the selected food items. The Geolocation API is used to detect and

track the devices locations.

III. SYSTEM DESCRIPTION

The main idea behind this paper is to propose a mobile application

that will support parents to monitor, control and educate their children

about the healthy eating habits and rapidly increasing their level of

alertness prior to undertaking unhealthy meals. The assigned doctors at

schools are also able to use this App to view the children captured food

data, send feedback, monitor a group of children following the

automatic transmission of uploaded data to the Internet every time the

tracking device is near a base station or when Wi-Fi feature has been

enabled. The transmitted data to the Internet using the IoT can then be

accessed and viewed by the parents and doctors. They can then be

provided with advice, suggest a proper alternative healthy food, and

suggest nearby healthy restaurants and grocery shops zone areas which

they can safely find fresh and healthier food.

The development methodology of the mobile was based on the agile

method as recommended in [23] which provides potential to deliver

enhanced and high quality of mobile application development lifecycle.

The users centered interface principles included in this work as per the

proposed approach in [24]. The architecture of the mobile app

comprises of three main layers; physical, network and web portal. These

aspects are summaries as follows:

A. Physical Layer

This layer also called the perception/ hardware layer that serves the

function of data acquisition from the implemented environment with

support of involved devices' sensors. It runs the communications among

smart objects and exchanges, processes and transmits the data to the

network layer [25].

B. Network Layer

This layer represents and serves the function of the connectivity

between the perception layer and the application layer. The devices'

sensor nodes are designed to send data to the base station [26]. At this

layer, data routing to different IoT devices are carried over the internet.

The network gateways, internet and switching operate through

telecommunication technologies such as Wi-Fi, 3G and Bluetooth. The

internet is used as essential component of this solution which facilitates

the networking infrastructure for the IoT nodes.

C. Application Layer

The establishment of IoT smart environment is usually achieved in

this layer. The proposed mobile health monitoring solution lies on top of

the aforementioned layers. The web system and mobile App interfaces

with different IoT objects residing at the perception layer such as other

third part systems, healthcare specialists, schools and hospitals. A

collection of web services exposed to users with the associated back-

office related modules that are facilitated through the integration with

other components including the SMS gateway and map location services.

These are referenced and called thru public API and with regards to

identification, authentication and data privacy that are maintained and

assured at the application layer. Furthermore, the application serves the

function of data storage, processing, monitoring and decisions based on

the constraints specified for users' authentication and verification

operations. For the user's access, different access modules created that

include children, parents and healthcare professionals. These stated

modules are explained in the following section.

D. End-users Modules

When designing applications using the IoT, users' interaction with

proposed systems must be considered [27]. As there is a large amount of

data transmitted from the connected IoT devices that require

authentication protocols to monitor and control the data exchanged. For

that purpose, identification of users' access has been set to different

profiles and privileges. The first module created for the children where a

child uses the mobile App to track food consumption by scanning food

items that have the QR codes. Reading and scanning QR codes usually

available as built-in features that most smartphone devices have.

However, some other smartphone devices do not have this feature which

requires manual installations of readers to read the QR codes on items.

The wearable device attached to the child's body allows transmission of

such data when synched over the internet using network access point, Wi-

Fi and Bluetooth to send the nutrimental information of scanned data.

Parents as well as health professionals upon receipt of data and access to

the web system can view, analyze and communicate with children

through a web portal to provide required notifications that include

advices, evaluations and recommendation of appropriate food items to

take, find safe zone areas of fresh food and healthy shops. The mobile

App uses the geolocation enabled feature to capture the location of child's

position indoors and outdoors and attach it with submitted nutrimental

data to the webserver. The parents and health professional module

includes a management system that enables accessing the web system to

monitor, view and analyze the logged data of users. The logged data

shows complete children profiles about their nutrimental status, Body

Mass Index (BMI), food consumption, steps taken, calorie burned and

weight. Apart from the management module, a communication system is

included to allow parents and health professionals to send messages to

children to encourage them on energetic needs, follow certain rules, go to

a food safe zone areas to undertake healthy meals...etc.

The research carried out by [28] showed that text messages

intervention acts as a mean to lose weight. In this research paper, a Short

Messages Service (SMS) has been used as text message-based

personalized services sent to the App's users twice a day. To make the

presented work as a complete solution for children obesity and control,

the social networks were utilized. Children tends to use social networks

such as Facebook and Instagram. Children, young and old people are

using the social networks to connect and share [31]. The proposed

mobile App has the functionality of utilizing social networks that allows

children to share their achievements to their parents, friends as well as

other users using different social networks. Figure 1 shows the various

layers with respect to the devices and services for the proposed mobile

application.

Figure 1 Abstract architecture of the System

Figure 1 presents the abstract architecture of the proposed mobile

app for obesity management and control with the main defined

components. In the meanwhile, the proposed system can be divided into

three main parts. The first part is the physical objects that include

devices such as fitness tracking, body sensors and attached medical

devices. The second part includes the smartphone that is primarily used

by end users including the children, parents and healthcare doctors. The

smartphone acts as an intermediary that receives the data from various

devices and processes them then automatically uploads data to the

server. In the servers' farm, a server that host the mobile App act as

healthcare information management system for obesity monitoring and

control. The backend server stores and manages App's component's

data. This data is saved on a remote backed server using HTTP with

implemented web services. The backend server contains all information

related to children personal data namely total volume of physical

activities, calories burned, blood pressure, intake food, saved QR codes,

and tracked geolocation information. The notification component allow

to send alert messages to end users on selected food items that may not

be healthy and encourage them with alternative food they should

undertake from the healthy food zone areas.

The IoT objects used in this paper include sensors and medical

devices that play a vital role to collect data from children. The fitness

tracking media [32] provides accurate calorie burn measurement,

temperature sensor, steps, sleeps and comes with accelerometer/

Bluetooth enabled that displays data in real time and automatically

synchronize wirelessly/ Bluetooth to upload logged food to the mobile

App repository server (backend). The QR-code has been used for this

mobile App as an alternative to Radio Frequency Identification (RFID)

as it requires all food items to include tags that may lead lot of end users

to change their devices to enabled Near Field Communication (NFC)

mobile phones. The QR codes are decoded easily with modern devices

as it requires having camera with built in reader/ scanner to scan food

items' QR-codes. The mobile App has different modules that include a

module for data receiving, processing and transmission to the server,

data retrieval, data settings, communication messages and location

tracking.

E. Children-Data Collection & Monitoring

The data collection, transmission and processing is illustrated in

Figure 2 and Figure 3.

Figure 2 Collection of data process

Figure 3 Parents and Doctors Feedback to Children

As depicted in Figure 1 the process of data collection involves the

measurement from the IoT attached objects such as the fitness tracking

device, blood pressure instrument and medical weight scale. All collected

measurements are then uploaded to the system backend and data can be

viewed by health doctors through the portal system as tabular and graphical

ways. Parents can also view the data using the mobile App to view and

track children's health status and history of the food intake along with all

relevant child's profile. Figure 2 provides the necessary feedback based on

the data collected and data processed including the summary of health

profile and medical status. (you need to refer to Figure 3 in the text)

IV. TECHNOLOGIES USED IN THE MOBILE SYSTEM

With the rapid increase of mobile devices usage, it is common that targeting

an independent applications that have very limited features is not all the

time feasible. The developed mobile applications must be able to share and

exchange data among users through various mobile component features

including the web services, data repository and push notifications. There

are many mobile Apps that offer such features which can run across

multiple platform and devices [33]. The proposed mobile App targets

Android platform devices which include key applications, operating system

and system middleware features for integration. The Eclipse Android

Developer Tool (ADT) was used for the application development. The rest

web services transmits messages over HTTP protocol with the portal online

services. The returned feedback from the system is passed through the

Extensible Markup Language (XML). For the maintainability purposes, the

look and feel of the mobile and online portal has been unified for future

updates and changes as per the design pattern needed. For security

improvements, the Model View Control (MVC) handles all the end-users'

functionalities and isolates the system data from any potential direct access.

Additionally, the MVC supports the system scalability of users' growth,

access and entire data resources that may increase. The PHP was used for

the implementation of the server side. The Java script, HTML5 and CSS

used for the front-end implementation.

Figure 4 Homepage & Login screens

Figure 5 Users tracking location and safe food areas screens

The primary design objectives of the mobile App have been

demonstrated with the extent to meet the expected users' needs. Figure

4 presents the users' homepage and login screens. In Figure 5, the parents

and healthcare professionals can use the geolocation button to track the

location of a child and use the interaction dialogues via SMS and email

for communications. Scanned food items' QR-codes are saved and stored

on the repository file upon successful synchronization with the system's

server to upload and process. For the advices and training programs,

doctors can use the advices module to generate and push notification to

a child or a group of children to follow certain instructions or dietary

program. Parents and doctors also can use this App to track the health

conditions and food intake status of children. As outlined in the

aforementioned section, users can access using account registered with

social media including the Instagram and Facebook which allows

children to share their achievements with friends and parents. This

feature is very helpful way to encourage them using the App.

V. MOBILE APP EVALUATION

To evaluate the use and acceptance levels of users, a pilot study had been

exercised which involved a sample size of 144 users. A correlation

analysis was conducted to identify the mutual relationship of system's

measurement variables that include trust, security, ease of use and

usefulness.

Figure 6 Correlation between Trust and Security

Figure 6 shows a significant correlation between Security and Trust

(R=0.362; p=0.00) which depicts that measure variable of security and

trust are highly correlated.

Figure 7 Correlation between Trust and Ease of Use

Figure 7 shows the association between Ease of Use and Security is

Significantly correlated (R=0.265; p=0.00) and which shows people are

taking care of these two factors together while choosing a mobile

application usage.

Figure 8 Correlation between Usefulness and Ease of Use

As depicted from Figure 8, Usefulness and Ease of use are significantly,

positively correlated (R=0.311; p=0.00). Which implies the users are

giving importance to ease of use and Usefulness

Figure 9 Correlation between Usefulness and Security

Figure 9 shows the correlation between security and usefulness is highly

significant and both are positively associated (R=0.577; p=0.000).

VI. CONCLUSION

This research paper presented a development of a mobile App for obesity

management and control targeting children as one of the main

objectives. The children as we mentioned in the earlier sections should

be 13 years and older to be able to use this App and with permission of

their parents. The proposed mobile App intended to help parents and

health doctors to monitor children who suffer from high obesity rates

and would use the technological advancement like mobile App to

encourage children to lose weight or maintain a healthy food intake.

Doctors can use online health system as well as mobile App to encourage

children to follow healthy instructions and dietary training programs and

monitor their progression via shared data on children social accounts

such as Instagram and Facebook. The IoT concept has been applied to

support the scan of food items using the QR-codes that enable children

to capture items' QR-codes and save them on the mobile devices using

the App and then upload it to the server for further data processing and

references. The fitness tracking devices has been used in this study to

allow monitoring users' health condition which include body weight,

blood pressure, calories burned, steps and physical activities. As future

work, the introduced mobile system has to be tested by different schools

such elementary and middle ones for testing and validation purposes.

The main contribution of this work are the integration of multiple mobile

devices. This is achieved using Android platform devices such as the

implementation of IoT concept, geolocation for tracking the children

locations, QR-codes as alternative way for quickly capturing food items

nutrimental information. All of which are integrated into this App as a

new approach of integrating recent mobile technology advancements.

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